Ultrasound-guided insulin injection for carpal tunnel syndrome in type 2 diabetes mellitus patients

Kamel, Shereen R.; Sadek, Hanaa A.; Hamed, Ayman; Sayed, Omima A; Mahmud, Mona H; Mohamed, Fatma; Sagher, Ghada M El; Aly, Lamia H.

doi:10.1007/s10067-019-04638-7

Cited by 7 publications

(11 citation statements)

References 29 publications

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“…Of the five other RCTs of UPIT using other injectates [ 58 , 59 , 60 , 61 , 62 ] ( Table 7 ), one compared HA with normal saline [ 58 ]; one evaluated hyaluronidase vs. steroids [ 59 ]; one investigated hyaluronidase vs. normal saline [ 60 ]; one compared insulin alone vs. steroids alone, steroids alone, and steroids followed by insulin [ 61 ]; and one evaluated ozone vs. steroids [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

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Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

Lam

Reeves

et al. 2023

Diagnostics

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Carpal tunnel syndrome (CTS) is the most common peripheral entrapment, and recently, ultrasound-guided perineural injection (UPIT) and percutaneous flexor retinaculum release (UPCTR) have been utilized to treat CTS. However, no systematic review or meta-analysis has included both intervention types of ultrasound-guided interventions for CTS. Therefore, we performed this review using four databases (i.e., PubMed, EMBASE, Scopus, and Cochrane) to evaluate the quality of evidence, effectiveness, and safety of the published studies on ultrasound-guided interventions in CTS. Among sixty studies selected for systemic review, 20 randomized treatment comparison or controlled studies were included in six meta-analyses. Steroid UPIT with ultrasound guidance outperformed that with landmark guidance. UPIT with higher-dose steroids outperformed that with lower-dose steroids. UPIT with 5% dextrose in water (D5W) outperformed control injection and hydrodissection with high-volume D5W was superior to that with low-volume D5W. UPIT with platelet-rich plasma outperformed various control treatments. UPCTR outperformed open surgery in terms of symptom improvement but not functional improvement. No serious adverse events were reported in the studies reviewed. The findings suggest that both UPIT and UPCTR may provide clinically important benefits and appear safe. Further treatment comparison studies are required to determine comparative therapeutic efficacy.

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Section: Resultsmentioning

confidence: 99%

“…Kamel et al [ 61 ] reported that ultrasound-guided injection with corticosteroids plus insulin, compared with corticosteroids alone, significantly decreased the CSA of MN. However, symptoms and functional outcomes did not differ between the groups.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

Lam

Reeves

et al. 2023

Diagnostics

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“…The lack of therapeutic response to splints or infiltrations supports the idea that the cardinal lesion of CTS in diabetic patients is not necessarily a repetitive microtrauma. However, as it has been previously suggested, it can have a triggering relationship [21][22][23].…”

Section: Discussionmentioning

confidence: 85%

Ultrasound Assessment of the Median Nerve Does Not Adequately Discriminate the Carpal Tunnel Syndrome among Patients Diagnosed with Diabetes

2021

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Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11.7 years old, 57.89% female, mean of time of evolution 13.6 ± 8.3 months) from 2012 to 2020. The cross-sectional area of the median nerve was 10.46 ± 1.44 mm2 in non-diabetic patients and 8.92 ± 0.9 mm2 in diabetic patients (p < 0.001). Additionally, diabetic patients had a shorter time of evolution (7.91 ± 8.28 months vs. 14.36 ± 0.526 months, p < 0.001). In the multivariate analysis, the resultant model (fixed R-square = 0.659, p = 0.003) included a constant of the following four variables: the evolution time (Beta coeff. = 0.108, p < 0.001 95% CI 0.091 to 0.126, standardized coeff. = 0.611), the condition of diabetes (Beta coeff. = −0.623, p < 0.001 95% CI −0.907 to −0.339, standardized coeff. = −0.152), the severity (Beta coeff. = 0.359, p = 0.001 95% CI 0.147 to 0.571, standardized coeff. = 0.169), and the masculine sex (Beta coeff. = 0.309, p = 0.003, 95% CI 0.109 to 0.509, standardized coeff. = 0.103). Conclusions: Ultrasound assessment of the median nerve in patients with diabetes is not a useful tool to confirm whether carpal tunnel syndrome should be diagnosed or not diagnosed.

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“…In the 18 selected randomized controlled trials, various injection treatment protocols were used. Three used dextrose [ 31 , 34 , 36 ], one used hyalase [ 30 ], one used insulin [ 33 ], 13 used steroid [ 26 , 27 , 29 , 32 – 35 , 37 – 39 , 41 , 42 ], one used hyaluronic acid [ 25 ], one used 17-Alpha-Hydroxyprogesterone [ 39 ], four used platelet-rich plasma [ 28 , 29 , 31 , 32 ], and one used ozone [ 27 ]. Normal saline injection was considered as placebo.…”

Section: Resultsmentioning

confidence: 99%

Injection therapy for carpal tunnel syndrome: A systematic review and network meta-analysis of randomized controlled trials

Yang,

Wang,

Kuo

et al. 2024

PLoS ONE

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Various injectants are available for the treatment of carpal tunnel syndrome. This systematic review and network meta-analysis was conducted to investigate the effectiveness of different injection therapies in alleviating the symptoms of carpal tunnel syndrome. Various databases were searched for relevant studies from inception until May 10, 2023. Eligible studies were identified using the patient (P), intervention (I), comparison (C), and outcomes (O) model, which involved (P) participants with carpal tunnel syndrome, (I) an intervention based on injection therapy, (C) the use of placebo or another injectant as a control treatment, and (O) the measurement of clinical and electrodiagnostic outcomes of interest. A total of 18 studies were included in the analysis. The network meta-analysis revealed that platelet-rich plasma is effective in the treatment of carpal tunnel syndrome in terms of symptom and pain relief and functional improvement in both the short and long term, whereas steroids are effective only in the short term. Additionally, injections of dextrose solution may offer long-term pain relief as well as short- and long-term symptom alleviation and functional improvement. The study findings suggest that platelet-rich plasma should be used as the first-line treatment for carpal tunnel syndrome, with dextrose and steroids serving as alternative treatment options.

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Ultrasound-guided insulin injection for carpal tunnel syndrome in type 2 diabetes mellitus patients

Cited by 7 publications

References 29 publications

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

Ultrasound Assessment of the Median Nerve Does Not Adequately Discriminate the Carpal Tunnel Syndrome among Patients Diagnosed with Diabetes

Injection therapy for carpal tunnel syndrome: A systematic review and network meta-analysis of randomized controlled trials

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